Blog » ‘You Expect Me to Do What?’ Three Major Challenges Nurse Leaders Face Today

‘You Expect Me to Do What?’ Three Major Challenges Nurse Leaders Face Today

Created May 21 2014, 08:00 PM by Lippincott Solutions
  • nurses
  • Medicare reimbursement
  • Nurse leaders
  • BSN

Thursday, May 22, 2014
Three Major Challenges Nurse Leaders Face Today

Bedside care draws many to the nursing profession. The opportunity to connect, comfort and make a difference in the lives of individual patients provides a reward like few others. Yet a frustrating reality of nursing practice in recent years is the significant amount of time nurses are spending on tasks not directly involving patients.

A 2012 study found that the majority of nurses spend one-quarter of their shift on indirect patient care activities, such as paperwork, documentation and restocking supplies. Other reports have estimated that nurses spend a mere 30% of their time with patients. An internal audit at Novant Health Presbyterian Medical Center in Charlotte, NC, however, shocked administrators when it revealed that nurses spent just 2.5 hours of a 12-hour shift in direct patient care at the bedside.

“Not only was that eye-opening, it was also completely unacceptable," the hospital’s chief clinical officer Sallye Liner, RN, told the Wall Street Journal. "We realized we needed to change the way we delivered care and get our nurses back to the bedside."

By implementing changes, the hospital increased the number of hours nurses spent at the bedside to an average 6.5 hours per 12-hour shift by the end of 2013, the newspaper reported. By the end of 2015, it aims to add another 2 hours to nurses’ bedside care average.

Whether your unit falls on the more extreme end of the spectrum or is more moderate in its example, chances are your nurses would appreciate the opportunity to spend more time at the bedside—and less time on the other stuff. Here are four strategies to free them up for what matters most: the patients.

Implement bedside charting. Documentation is obviously an essential part of patient care. But the duty doesn’t have to be as far removed from patients as it once was. Hospitals are increasing caregivers’ time with patients by installing computers by the bedside or using laptops and tablets to allow them to document on the spot.

Deter distractions. Nurses can get through their away-from-the-bedside responsibilities quicker when they are not interrupted. Hourly rounding can go a long way toward cutting back on the frequency of call bells. Patients who know that their nurses will check in on them at specific times have their needs met, and will often hold off on non-urgent requests while their nurse is otherwise engaged.

At Virginia Mason Medical Center, Seattle, nurses put a stop to interruptions while they were at the automated medication dispensing cabinet by marking the area with red tape and posting a sign prohibiting conversation with the nurse in the dispensing zone. The intervention streamlined the medication administration process, saved time and promoted patient safety (through decreased distractions) to boot. 

Decrease steps. Fitness campaigns may encourage 10,000 steps a day, but they shouldn’t all happen during a nurse’s workday. Nurses can log miles in steps all over the hospital tracking down medications, supplies and other equipment due to inefficiencies in the system. To reduce this, make sure patient rooms are stocked with supplies and extra linens at all times. Arrange for pharmacists to deliver medications to the unit. Nurses stations, too, should be located in a spot central to all patient rooms. 

Provide support (staff). Hospitals can stem nurse burnout and reduce turnover (thus saving money) by investing in support staff such as licensed practical nurses and certified nurse assistants (CNAs). Novant Health Presbyterian Medical Center reportedly saved millions by adding CNAs and shifting to a more team-based model of care. In addition, patients are happier and pushing fewer call buttons. Still, one clinical nurse leader told the Wall Street Journal that the transition wasn’t automatic—nurses actually took classes on responsibility delegation.

“We were so used to taking care of everything,” she said. “We now are more comfortable telling the CNAs, 'I need a catheter inserted,' instead of doing it ourselves."